Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan, USA.
University of Michigan Medical School, Ann Arbor, Michigan, USA.
Cerebrovasc Dis. 2022;51(2):207-213. doi: 10.1159/000518729. Epub 2021 Sep 7.
Acute stroke treatments are underutilized in the USA. Enhancing stroke preparedness, the recognition of stroke symptoms, and intent to call emergency medical services (EMS) could reduce delay in hospital arrival thereby increasing eligibility for time-sensitive stroke treatments. Whether higher stroke preparedness is associated with higher tissue plasminogen activator (tPA) treatment rates is however uncertain. We therefore set out to determine the contribution of stroke preparedness to regional variation in tPA treatment.
The region was defined by hospital service area (HSA). Stroke preparedness was determined by using Behavioral Risk Factor Surveillance System survey questions assessing stroke symptom recognition and intent to call 911 in response to a stroke. We used Medicare data to determine the percentage of tPA-treated hospitalized stroke patients in 2007, 2009, and 2011, adjusting for number of stroke hospitalizations in each HSA (primary outcome). We performed multivariate linear regression to estimate the association of regional stroke preparedness on log-transformed tPA treatment rates controlling for demographic, EMS, and hospital characteristics.
The adjusted percentage of stroke patients receiving tPA ranged from 1.4% (MIN) to 11.3% (MAX) of stroke/TIA hospitalizations. Across HSAs, a median (IQR) of 86% (81-90%) of responses to a witnessed stroke indicated intent to call 911, and a median (IQR) of 4.4 (4.2-4.6) out of 6 stroke symptoms was recognized. Every 1% increase in an HSA's intent to call 911 was associated with a 0.44% increase in adjusted tPA treatment rate (p = 0.05). Lower accuracy of recognition of stroke symptoms was associated with higher adjusted tPA treatment rates (p = 0.05).
There was little regional variation in intent to call EMS and stroke symptom recognition. Intent to call EMS and stroke symptom recognition are modest contributors to regional variation in tPA treatment.
在美国，急性中风治疗的应用不足。提高中风准备程度、识别中风症状以及拨打紧急医疗服务（EMS）的意愿，可能会减少到达医院的时间延迟，从而增加接受时间敏感型中风治疗的机会。然而，较高的中风准备程度是否与更高的组织型纤溶酶原激活剂（tPA）治疗率相关尚不确定。因此，我们旨在确定中风准备程度对 tPA 治疗区域差异的贡献。
该区域由医院服务区（HSA）定义。中风准备程度通过使用行为风险因素监测系统调查问题来确定，这些问题评估了对中风的症状识别和拨打 911 的意愿。我们使用医疗保险数据来确定 2007 年、2009 年和 2011 年接受 tPA 治疗的住院中风患者的百分比，同时调整每个 HSA 中风住院人数（主要结果）。我们进行多元线性回归分析，以估计区域中风准备程度对 log 转换 tPA 治疗率的关联，同时控制人口统计学、EMS 和医院特征。
接受 tPA 治疗的中风患者的调整百分比范围为中风/TIA 住院患者的 1.4%（MIN）至 11.3%（MAX）。在 HSA 之间，有中位数（IQR）为 86%（81-90%）的人对目击到的中风表示有拨打 911 的意愿，中位数（IQR）为 4.4（4.2-4.6）个中风症状被识别。HSA 拨打 911 的意愿每增加 1%，调整后的 tPA 治疗率就会增加 0.44%（p = 0.05）。中风症状识别的准确性降低与调整后的 tPA 治疗率升高相关（p = 0.05）。
在拨打 EMS 和识别中风症状的意愿方面，区域间差异很小。拨打 EMS 的意愿和中风症状的识别是 tPA 治疗区域差异的适度贡献因素。
